Could a serious diabetic foot risk remain undetected in routine outpatient care? A cross-sectional study published in the International Journal of Diabetes in Developing Countries found that nearly half of patients with type 2 diabetes mellitus (T2DM) without known active ulcers had moderate-to-high diabetic foot syndrome (DFS) risk, while 10% had an undiagnosed ulcer at initial assessment.

The study evaluated 530 adults with T2DM attending an outpatient diabetes clinic. Each participant underwent a comprehensive foot examination and was classified into four International Working Group on the Diabetic Foot (IWGDF) risk categories. Demographic, clinical, and biochemical parameters were compared across risk groups using standard statistical methods.

Overall, 24.2% were classified as moderate risk and 20.8% as high risk. Higher risk categories were significantly associated with older age (P<0.001), longer diabetes duration (P<0.001), higher glycated hemoglobin (HbA1c) levels (P=0.012), and increased waist circumference (P<0.001).

Renal dysfunction also rose across risk groups, including reduced glomerular filtration rate (GFR) and microalbuminuria (both P<0.001). Peripheral neuropathy and peripheral artery disease increased progressively with higher risk classification (both P<0.001). These findings suggest routine IWGDF-based screening may help detect high-risk patients earlier and support strategies to reduce ulceration and amputation.